Becoming a PE Qualified Entity

Medicaid providers must be trained and certified by the KDHE Division of Health Care Finance (KDHE-DHCF) prior to making Presumptive Eligibility (PE) determinations. In order to become certified, the Medicaid provider must fulfill the following requirements:

  1. Complete and submit a Presumptive Eligibility Statement of Interest to KDHE-DHCF.
  2. A Memorandum of Understanding (MOU) contract must be drafted, agreed to and signed by both the hospital or entity’s CEO or executive director and the KDHE Secretary. An implementation plan will be agreed to and followed.
  3. Each individual Entity must have specialized PE workers complete the KanCare Presumptive Eligibility Training in order to complete PE determinations at their facilities.

Qualified Entity Responsibilities

The KanCare Presumptive Eligibility Program includes both Hospitals and Clinics, but their ability to make determinations is not the same.

Qualified hospitals are Medicaid provider hospitals that go through the qualification process and agree to make presumptive eligibility determinations consistent with KDHE policies and procedures. They can make Medicaid PE determinations for:

  • Pregnant women
  • Infants and Children under age 19
  • Low income parents and caretakers
  • Former Kansas Foster Care Children (Ages 18-25)
  • Breast and Cervical Cancer recipients diagnosed and currently receiving ongoing treatment through the Early Detection Works program

Qualified hospitals may allow any clinic owned by the hospital to make Medicaid presumptive eligibility determinations.

Qualified clinics are entities that are Medicaid providers, but are not owned or operated by a hospital, that go through the qualification process and agree to make presumptive eligibility determinations consistent with KDHE policies and procedures. They can make Medicaid PE determinations for:

  • Pregnant women
  • Infants and Children under age 19

Qualified Entities:

Can make presumptive eligibility determinations for:

Children

Pregnant Women

Former Foster Care, Parents, and Caretakers

Qualified Hospitals

X

X

X

Providers

X

X

 

 

Guidelines must be followed as to the follow-through and accuracy of PE determinations or the state has the authority to take corrective action, including termination from the PE program. If performance standards are not met, the entity will receive written notification from KDHE-DHCF.